Escalation or ­induction?

Treatment of relapsing-remitting multiple sclerosis

Publication Date: 14.02.2018
Swiss Arch Neurol Psychiatr Psychother. 2018;169(02):38-39

Marie Théaudin, Gilles Edan

Please find the affiliations for this article in the PDF.


Standard therapy for the majority of multiple sclerosis patients is escalation therapy. Induction therapy may be indicated for severe and active multiple sclerosis. The only two pharmacological agents that can be used for an ­induction approach are alemtuzumab and mitoxantrone because of their prolonged residual effect. Brain magnetic resonance imaging is a key examination for monitoring patients with relapsing-remitting multiple sclerosis.

Keywords: escalation induction multiple sclerosis treatment, escalation inductionmultiple sclerosistreatment


Extensive advances in multiple sclerosis treatment options have revolutionised multiple sclerosis treatment ­approaches. After a period when escalation therapy was considered the main option for relapsing-remitting multiple sclerosis, there is now increasing interest in using induction therapy in selected patients.


Widening of the therapeutic arsenal in multiple sclerosis opens up new perspectives bringing greater opportunity for ­personalised therapy. However, detailed guidelines, based on general consensus, that ­define treatment efficacy at the individual level have yet to be published. ­Randomised trials testing the benefit and safety of early induction therapy, and comparing escalation with induction therapy are warranted. Finally, the neuro­logist today faces new problems, including management of short- to long-term side effects, of treatment switches, and of pregnancy in patient of childbearing potential.

Funding / potential competing interests

Dr Théaudin received speaker honoraria from Genzyme and Merck, travel grant from Novartis and Biogen.


Marie Théaudin, MD PhD
Department of Neurology, CHUV, avenue du Bugnon 46, CH1011 Lausanne


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